Unusual Infectious Complications of Skull Base Surgery

Purpose: Increasingly, complex skull base procedures contain the same risks of infectious complications of any surgical procedure. Many of these, however, may be hidden, leading to a delay in ultimate diagnosis and appropriate treatment.

Materials and Methods: A case series of three individuals seen following skull base procedures at the University of Virginia with unusual infectious manifestations are explored for clues that assist in making the diagnosis.

Results: All three patients presented with orbital apex syndrome with decreased vision, pain, varying degrees of proptosis, and ophthalmoplegia. Imaging indicated pathology in the orbital apex and superior orbital fissure but often multiple biopsies were required to make a definitive diagnosis and initiate treatment. Aggressive antibacterial treatment was effective in eliminating the infectious process in two of the three patients.

Conclusions: Infectious processes may occur in the orbital apex and superior orbital fissure following endoscopic and open skull base procedures. Radiation therapy may further predispose to infectious processes. Aggressive and often repeat biopsies may be necessary to make a diagnosis. Cranial nerve palsies may reverse with treatment.